Physicians: Senate health IT bill would give unfair ratings

Senate Health, Education, Labor and Pensions Committee leaders are negotiating changes to a health information technology bill that aims to assuage physicians' groups who are objecting to language creating a physician rating system based on federal claims data. A senior Republican aide said language being added would require that before the ratings are publicly released, the formula will be adjusted to take into consideration patients' health conditions.

The negotiations also are attempting to involve healthcare providers in preparing quality measurement reports to ensure they account for patient risk factors, the aide added. The bill is aimed at jump-starting a nationwide electronic health records program.

John Hedstrom, assistant director of government relations for the Society of Thoracic Surgeons, said the new language is not enough because federal claims data -- which includes enrollments and payments -- do not allow for an adjustment based on patients' health conditions or risk factors.

"Claims data in and of itself is just rife with inaccuracies," Hedstrom said. An alliance of 36 physician organizations, including the American Medical Association, sent a letter Nov. 9, followed by a Nov. 13 letter from the surgeons' group, warning senators that federal claims data will produce an inaccurate rating system. Instead, the groups want the health information technology bill to create a system that relies on clinical data already being gathered and used to develop quality measures by individual organizations or a consortium convened by the American Medical Association.

Michael Hogan, director of government relations for the Society of Thoracic Surgeons, said federal claims data relying on enrollment and reimbursement information cannot be adjusted for risk.

"Billing data won't tell you whether the patient has diabetes or many clinical risk factors that make them difficult patients, and the doctors that treat the sickest patients get punished for it," Hogan said.

He noted that about 15 specialties are creating their own quality measures based on clinical data, and that electronic records would create more clinical data. The letter from the 36 physician groups recommends a consensus process such as the American Medical Association's Physician Consortium on Performance Improvement, which has developed 200 quality measures.

The federal claims language was included by Sen. Judd Gregg, R-N.H., before the HELP Committee marked up the bill in June to enable patients to assess quality using all available data. An aide said business healthcare groups as well as the Service Employees International Union and AARP support changes under negotiation. Negotiators would like to finish up next month and hotline the bill to bring it up for unanimous consent.

"There's a chance," Senate HELP ranking member Michael Enzi, R-Wyo., said late last week. "We keep working with everybody that's got some special interest in it."

Enzi expressed frustration that the bill the Senate passed by unanimous consent two years ago is running into roadblocks.

"It should have happened already," he said.

Senate Judiciary Chairman Patrick Leahy, D-Vt., also is in negotiations to include privacy protections in the bill. An aide said Leahy has concerns about third parties gaining access to electronic health records.